Author Archives: Jackie Aim

What is wheeze?

Breathing noises are common in small children and it can be difficult to know the difference between these noises. Most children will have colds and snuffles several times a year for example.

The following sound clips have been made to help you hear and learn the difference between the following common breathing sounds:

1. Stridor – Is a noisy grunting sound made when breathing in. It is made in the neck area and not in the lungs. You should seek help from your GP.


Select the play button above to listen to an example of stridor.

2. Upper airway noise – This sound is made in the back of the throat and the upper airway. It sounds a little bit like a snore and can sound moist.  This sound is commonly wrongly identified as a wheeze by many parents.


Select the play button above to listen to an example of an upper airway noise.

3. Wheeze – This sound is only made as your child is breathing out. It comes from the chest and the sound has an almost musical note. It takes effort to breathe out. Often the child will be breathing faster. You can often see the child will be sucking in their chest muscles around the ribs and at the neck muscles. This is the sound which is heard in children with asthma. However, this does not necessarily mean your child has asthma. Some children may still have asthma without wheeze. They may still need further tests or an appointment with a specialist to make a diagnosis.


Select the play button above to listen to an example of a wheeze.

If your child makes a breathing sound that you are concerned about, you can help the doctors or nurses understand the noises you have heard by using your mobile phone to record them while your child is wheezing. If in any doubt get your child checked by a doctor.

Medicines to take care with

© Crown Copyright 2009

© Crown Copyright 2009

It is best to take advice from pharmacist or doctor before using these medicines. Speak to your GP or pharmacist if you are concerned about any medication that might affect your asthma.

  • Anti-inflammatory medicines including
    • Ibuprofen (Nurofen®)
    • Aspirin (Anadin®)

    can make asthma symptoms worse in a small number of people.
    These are common drugs contained in preparations for coughs and colds and pain.
    They can be bought over the counter from a pharmacy.

    Always check the ingredients of any painkillers or anti-inflammatory drugs or ask the pharmacist for advice.

  • Beta blockers (including atenolol or any drug ending in ‘lol’) – these can cause the airways to tighten and prevent reliever medication from working.

Spacer devices

Aerochamber

Aerochamber

Large volume spacer

Large volume spacer

Here are some examples of spacer devices. They are used together with your metered dose inhaler and are useful if you have difficulty coordinating your breath in (as you press the inhaler) and after as you hold your breath.

A spacer holds the drug in the chamber which gives you time to breathe in and out. You can take more than one breath to get the medication into your lungs.

Watch a video from Itchy Sneezy Wheezy on using an inhaler with a spacer.

Spacer devices:

  • Should be washed once a month with warm soapy water and left to air dry.
  • Don’t dry them with a towel as this can build up static in the spacer and stop it working properly.
  • They usually last 6-12 months before they need replaced.

Self management

Spacer devices are also used for ‘multi-dosing’. This is a great way of getting medication to the lungs especially in asthma attacks – in actual fact this method is as effective as using a nebuliser. The inhaler should be fitted into the spacer after shaking, pressed once and inhaled normally over 5 – 10 breaths. These steps should then be repeated as directed, usually for between 5 and 10 doses of the inhaler, shaking before doses as usual. It is important though that each dose is inhaled separately – it won’t be as effective if more than one dose is fired from the inhaler rapidly after each other, they need to be given and taken individually; multi-dosing means taking more than the usual two puffs via the spacer.

Antihistamines

Antihistamines reduce the amount of histamine the body releases in response to an allergen. Histamine can cause irritation of the lining of the nose and tightening of the airways.

Drug name Device How its taken Side effects
Azelatine (Rhinolast®) Nasal spray antihistamine spray How often? Take as prescribed by your doctor.

  • Blow your nose and shake the bottle.
  • Tilt your head forward.
  • Hold the spray bottle upright.
  • Insert the tip of the spray bottle just inside one nostril. Close the other nostril with your other hand, and apply one or two sprays as prescribed.
  • Breathe in as you spray (but do not sniff hard as the spray then travels past the nose to the throat).
  • Do not angle the canister towards the middle or side of the nose, but straight up. With your head tilted forward, the spray should go to the back of your nose.
  • Repeat in the other nostril.
  • Some antihistamines can make you feel drowsy. If you experience this please do not drive or operate machinery.
  • Other side-effects include an upset stomach, headache and restlessness
  • If you experience symptoms that suggest an allergic reaction seek medical advice as soon as possible
  • Information on other side-effects can be found in the Patient Information Leaflet in the pack or through the Electronic Medicines Compendium (EMC) website
  • Cetirzine (Zirtek®)
  • Levocetirizine (Xyzal®)
  • Loratadine (Clarityn®)
  • Desloratadine (Neoclarytin®)
  • Fexofenadine (Telfast®)
  • Hydroxyzine (Atarax®, Ucerax®)
  • Chlorphenamine (Piriton®)
  • Promethazine (Phenergan®, Avomine®)
  • Clemastine (Tavegil®)
 Tablets / liquid antihistamine syrup and tablets

Please note:

These are the most commonly used nasal spray, tablets or liquid at the time of publication of this website. If you do not see your spray, tablets or liquid you can speak to your GP or pharmacist or check the patient information leaflet for your medication.

Nasal steroid treatments

Please note there is no audio for this animation.

Drug name Device How its taken Side effects
  • Beclometasone (Beconase®, Nasobec®)
  • Budesonide (Rhinocort®)
  • Fluticasone (Flixonase®, Avamys®, Nasofan®)
  • Mometasone (Nasonex®)
  • Triamcinolone (Nasacort®)
 Nasal spray How often? Use as prescribed by your doctor. It may take a few days for this type of medication to work.

  • Blow your nose and shake the bottle.
  • Tilt your head forward.
  • Hold the spray bottle upright.
  • Insert the tip of the spray bottle just inside one nostril. Close the other nostril with your other hand, and apply one or two sprays as prescribed.
  • Breathe in as you spray (but do not sniff hard as the spray then travels past the nose to the throat).
  • Do not angle the canister towards the middle or side of the nose, but straight up. With your head tilted forward, the spray should go to the back of your nose.
  • Repeat in the other nostril.
 Side effects of nasal steroids include: Unpleasant taste and smell, nasal and throat dryness/irritation.
– Longer term side-effects of nasal corticosteroids may occur particularly when used at high doses for prolonged periods.
High doses can cause long term effects – It is important you attend regular asthma reviews to assess your treatment and reduce the risk of long term side-effects.Information on other side-effects can be found in the Patient Information Leaflet in the pack or on the electronic Medicines Compendium (eMC) website.Most side effects are short lasting and common. They are not a reason to stop taking the inhaler. Most people tolerate these mild side effects. If you are in any doubt contact your GP or asthma team.

Please note:

These are the most commonly used nasal sprays at the time of publication of this website. If you do not see your nasal spray you can speak to your GP or pharmacist or check the patient information leaflet for your medication.

Preventers – tablets

Preventer tablets block the effects of substances (called leukotrienes) which can cause tightening of the airways.

View text alternative

Medicine name How its taken Device Side effects
Montelukast (Singulair®)
  • Used regularly as preventive medication
  • Taken as tablets and usually added in to inhaler treatment if asthma symptoms are not controlled
 Tablets, chewable tablets and granules
  • All medicines have side-effects
  • Common ones include stomach pains and headaches
  • If you experience symptoms that suggest an allergic reaction seek medical advice as soon as possible
  • Information on other side-effects can be found in the Patient Information Leaflet in the pack or through the following electronic Medicines Compendium (eMC) website
Zafirlukast (Accolate®) Preventer – taken regularly every morning and evening. Only used for children over 12. Tablets

Please note:

These are the most commonly used tablets at the time of publication of this website. If you do not see your tablets you can speak to your GP or pharmacist or check the patient information leaflet for your medication.

Combination inhalers

Combination inhalers:

  • Are a combination of a steroid and a long acting reliever.
  • Can be used when a steroid alone does not control asthma symptoms.
  • Are a treatment which can be stepped up and down according to asthma control.

View text alternative

Drug name Device How its taken Side effects
Beclometasone/Formoterol (Fostair®) Metered dose inhaler, NEXThaler
  • Combination of a steroid and a long acting reliever
  • Used when a steroid alone does not control asthma symptoms
  • Treatment can be stepped up and down according to asthma control
 Common side effects include: shakiness, headaches and palpitations. If you experience symptoms that suggest an allergic reaction seek medical advice as soon as possible.

With steroids you can get an increased number of infections including oral thrush. Some practical tips on avoiding oral thrush are:

  • Wash your mouth out and/or brush your teeth after using your inhaler
  • Make sure you are using your inhaler correctly
  • You may need to use a spacer device

High doses of steroids can cause long term effects – It is important you attend regular asthma reviews to assess your treatment and reduce the risk of long term side-effects.

Information on other side-effects can be found in the Patient Information Leaflet in the pack or on the electronic Medicines Compendium (eMC) website.

Most side effects are short lasting and common. They are not a reason to stop taking the inhaler. Most people tolerate these mild side effects. If you are in any doubt contact your GP or asthma team.Budesonide/Formoterol (Symbicort®, DuoResp®)Turbohaler, SpiromaxFluticasone/Formoterol (Flutiform®)Flutiform inhalerFluticasone/Salmeterol (Seretide®)Metered dose inhaler, AccuhalerFluticasone Furoate/Vilanterol (Relvar Ellipta®)Ellipta inhaler

Please note:

These are the most commonly used inhalers at the time of publication of this website. If you do not see your inhaler you can speak to your GP or pharmacist or check the patient information leaflet for your inhaler and medication.

Preventers – steroid inhalers

Preventers are used to reduce the inflammation in the lining of the lungs. This reduces the tightening of the airways and means breathing becomes easier.
They are used regularly as a preventative medicine.  These inhalers do not give instant relief of symptoms and when you start to use them, they need time to become effective and should be taken regularly as prescribed by your doctor or respiratory specialist nurse.


View text alternative

Drug name Device How its taken Side effects
Beclometasone (Clenil Modulite®, Qvar®, Asmabec®) Metred dose inhaler, Clickhaler, Qvar, Easyhaler Preventer – taken regularly every morning and evening. You can get an increased number of infections including oral thrush. Some practical tips on avoiding oral thrush are:
  • Wash your mouth out and/or brush your teeth after using your inhaler
  • Make sure you are using your inhaler correctly
  • You may need to use a spacer device

High doses can cause long term effects – It is important you attend regular asthma reviews to assess your treatment and reduce the risk of long term side-effects.

Information on other side-effects can be found in the Patient Information Leaflet in the pack or on the electronic Medicines Compendium (eMC) website.

Most side effects are short lasting and common. They are not a reason to stop taking the inhaler. Most people tolerate these mild side effects. If you are in any doubt contact your GP or asthma team.Budesonide (Pulmicort®, Budelin Novolizer®)Easyhaler, TurbohalerFluticasone (Flixotide®)Metred dose inhaler, AccuhalerMometasone (Asmanex®)TwisthalerCiclesonide (Alvesco®)Qvar

Please note:

These are the most commonly used inhalers at the time of publication of this website. If you do not see your inhaler you can speak to your GP or pharmacist or check the patient information leaflet for your inhaler and medication.